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Surgeons evidently don't need sleep as much as I do, and when it comes to pertussis, the real danger is inside the house. This is Healthcare Triage News.

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Aaron: Surgeons evidently don't need sleep as much as I do. And when it comes to Pertussis, the real danger is inside the house. This is Healthcare Triage News.

First up from the New England Journal of Medicine, outcomes of daytime procedures performed by attending surgeons after night work. When I was a resident back in the long ago, there were any number of times when I worked for like 36 hours straight. I'd get to work at like six or seven in the morning, work all day then all night, and then stay on until late the next afternoon. I wasn't just pushing paper either.

Lots of these times I was covering places like the infant intensive care unit and performing procedures in the middle of the night after having not slept. I always worried that the quality of care would suffer; I know the quality of my person did. And that's why I was so interested in this study.

Researchers in Canada created a cohort of patients operated on by physicians who either did or did not treat patients between the hours of midnight and 7 a.m. the night before. They matched patients who underwent the same procedure by the same position on a day when that Doc had worked at night or didn't.

They looked at the rates of death, re-admissions, complications, procedure duration, and length of stay. There were almost 40,000 patients in this study, treated by almost 1,450 surgeons, and about 40% of the procedures occurred at an academic center.

There were no significant differences in the adjusted rates of death (1.1% in both groups), in re-admissions (6.6% vs 7.1%), or in complications (18.1% vs 18.2%) between the two groups. The median length of stay was three days, and again there were no differences between the groups. The median duration of surgery was 2.6 hours, and the interquartile ranges were almost identical- no significant differences there either.

Now there's a lot of research out there that shows that being sleep-deprived is bad for care. It's possible that the previous studies showing differences between those who are more and less sleep deprived may have focused on trainees versus attending physicians in this study, and the latter may be better. It's also possible that the surgeons exercise better judgment and recuse themselves when they're potentially a danger to patients. It's also possible that surgeons are different from the rest of us. Or maybe I just need sleep more than they do.

This study provides a nice data point, showing that surgeons caring for patients in the middle of the night don't appear to be putting their patients at significant risk, and that's good news for everyone.

Our second story is from this month's pediatrics- sources of infant Pertussis infection in the United States. Pertussis which causes whooping cough, is much less of a problem than it used to be because of the vaccines we give infants, but it keeps on trying to come back. We've believed for a long time that mothers are the most common source of transmission of the disease, which is why we try and make sure that they themselves are immune. As we're getting better at immunizing people, whooping cough keeps on roaring back.

So researchers want to see if there might be changing sources of the disease. So they looked to cases identified by the Enhanced Pertussis Surveillance sites from 2006 through 2013. Patient interviews were conducted to identify the source of infection, mainly by trying to detect infected people who might have come into contact with babies one to three weeks before they got sick.

They identified more than 1,300 cases, about a quarter of whom were less than two months old and therefore totally unimmunized. More than two-thirds of the sources of infection were family members. The most common source of infection overall was a sibling (at 36%), followed by moms (at 21%), and dads (at 10%).

This was a new ordering. Mothers were the most common source until 2008, when siblings took over. The median age range for siblings who transmitted Pertussis to their newborn brothers or sisters was eight years old. Interestingly, this shouldn't change our prevention strategy too much. There's debate out there about whether cocooning strategies, where we vaccinate adolescent and adult close contacts of newborns- with a single dose of Tdap on top of pregnancy Tdap boosters- makes much of a difference.

What is still believed to be the most impactful intervention is for expecting mothers to get re-vaccinated somewhere between the 27th and 36th week of pregnancy. This allows them to create antibodies and pass them along to their babies in utero, which can provide some protection until the newborns get their own vaccines starting at two months of age. And of course keep sick contacts away from babies- common sense people.

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